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This publication is provided for historical reference only and the information may be out of date.

Cover of Telemedicine for the Medicare Population: Update

Telemedicine for the Medicare Population: Update

Evidence Reports/Technology Assessments, No. 131

Investigators: , MD, Principal Investigator, , MD, MPH, , MPH, , MLS, , AMLS, MA, and , MD, MS, EPC Director.

Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 06-E007

Structured Abstract

Context:

Telemedicine services are increasingly utilized by patients, clinicians, and institutions. Although private and Federal insurers are covering some telemedicine services, the rationale for these coverage decisions is not always evidence-based.

Objectives:

The goal of this report was to assess the peer-reviewed literature for telemedicine services that substitute for face-to-face medical diagnosis and treatment that may apply to the Medicare population. We focused on three distinct areas: store-and-forward, home-based, and office/hospital-based services. We also sought to identify what progress had been made in expanding the evidence base since the publication of our initial report in 2001 (AHRQ Publication No. 01-E012.)

Data Sources:

Ovid MEDLINE®, reference lists of included studies, and non-indexed materials recommended by telemedicine experts.

Study Selection:

Included studies had to be relevant to at least one of the three study areas, address at least one key question, and contain reported results. We excluded articles that did not study the Medicare population (e.g., children and pregnant adults) or used a service that does not require face-to-face encounters (e.g., radiology or pathology diagnosis).

Data Extraction:

Our literature searches initially identified 4,083 citations. Using a dual-review process, 597 of these were judged to be potentially relevant to our study at the title/abstract level. Following a full-text review, 97 studies were identified that met our inclusion criteria and were subsequently included in the report's evidence tables.

Data Synthesis:

Store-and-forward services have been studied in many specialties, the most prominent being dermatology, wound care, and ophthalmology. The evidence for their efficacy is mixed, and in most areas, there are not corresponding studies on outcomes or improved access to care.

Several limited studies showed the benefits of home-based telemedicine interventions in chronic diseases. These interventions appear to enhance communication with health care providers and provide closer monitoring of general health, but the studies of these techniques were conducted in settings that required additional resources and dedicated staff.

Studies of office/hospital-based telemedicine suggest that telemedicine is most effective for verbal interactions, e.g., videoconferencing for diagnosis and treatment in specialties like neurology and psychiatry.

Conclusions:

There are still significant gaps in the evidence base between where telemedicine is used and where its use is supported by high-quality evidence. Further well-designed and targeted research that provides high-quality data will provide a strong contribution to understanding how best to deploy technological resources in health care.

Contents

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0024. Prepared by: Oregon Evidence-based Practice Center, Portland, OR.

Suggested citation:

Hersh WR, Hickam DH, Severance SM, Dana TL, Krages KP, Helfand M. Telemedicine for the Medicare Population: Update. Evidence Report/Technology Assessment No. 131 (Prepared by the Oregon Evidence-based Practice Center under Contract No. 290-02-0024.) AHRQ Publication No. 06-E007. Rockville, MD: Agency for Healthcare Research and Quality. February 2006.

This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC), under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0024). The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

1

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

Bookshelf ID: NBK37953
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